Provider Demographics
NPI:1487222444
Name:MARTIN DENTISTRY PC
Entity Type:Organization
Organization Name:MARTIN DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-247-8172
Mailing Address - Street 1:4260 FORT HENRY DR STE 13
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2248
Mailing Address - Country:US
Mailing Address - Phone:423-247-8172
Mailing Address - Fax:
Practice Address - Street 1:4260 FORT HENRY DR STE 13
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2248
Practice Address - Country:US
Practice Address - Phone:423-247-8172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTIN DENTISTRY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-16
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental